Sexual Dysfunction & Intimacy Concerns
Sexual Dysfunctions (DSM-5-TR)
Difficulties with sexual desire, arousal, orgasm, pain during sex, or overall sexual satisfaction that cause personal distress or interpersonal difficulty. Includes desire discrepancy, erectile dysfunction, anorgasmia, vaginismus/genito-pelvic pain, and intimacy avoidance. Often intertwined with relational dynamics, body image, trauma history, medical factors, and cultural/religious messaging about sexuality.
Prevalence: ~44% of US women and ~31% of men report some sexual problem, but only ~12% of women report a sexual problem accompanied by distress, which is what a DSM-5-TR diagnosis requires. Prevalence varies sharply by specific condition, age, and gender
Clinical Picture
Sexual dysfunction and intimacy concerns span a wide range: from specific physiological issues (erectile dysfunction, vaginismus, anorgasmia) to desire discrepancy in couples, to the broader psychological and relational dimensions of sexual experience. Effective treatment often requires attention to multiple levels simultaneously: the physiological, the psychological (anxiety, body image, trauma history), the relational (communication, power dynamics, emotional safety), and the cultural (messages about sexuality, gender roles, religious frameworks). Many therapists are uncomfortable with explicit sexual content and avoid it even when it's clinically relevant.
Treatment Considerations
Sex therapy draws from behavioral (sensate focus, originally Masters and Johnson), cognitive (addressing performance anxiety and sexual schemas), and relational (improving communication and emotional intimacy) approaches. For sexual dysfunction with trauma history, trauma-processing often needs to precede or accompany sex-specific interventions. EFT and Gottman approaches address the relational dimension of sexual disconnection. For specific dysfunctions, medical evaluation should be part of the workup. Therapists treating sexual concerns need specialized training: general clinical training is insufficient.
Approaches and Evidence
Of 6 associated approaches, 1 have completed assessments for this topic, 0 have source checks awaiting assessment, and 5 have neither recorded yet. Each completed assessment states its population and rationale; source checks alone do not establish effectiveness. These categories describe different findings and review stages; they are not a ranking of treatments.
Guideline recommendation (1)
These assessments record a guideline recommendation for the stated population. Read the scope and rationale; a broad topic label does not make a recommendation applicable to everyone.
Cognitive Behavioral Therapy
Aaron Beck · 1964
Reviewed population: Men with erectile dysfunction, when an ED-focused cognitive behavioural intervention is indicated, including the partner and combined with medical treatment.
EAU 2026 section 5.6.12 gives a strong recommendation for CBT in this indicated, combined-care context; section 5.6.4 describes psychosocial approaches. Medical and sexual assessment remains part of ED care. This does not establish CBT as sole treatment, grade every CBT protocol, or cover every sexual dysfunction or intimacy concern.
Reviewed
Guidelines and official sources (1)
1 clinical guideline check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Sexual and Reproductive Health: Management of Erectile Dysfunction
Recommendation for the stated population
EAU gives a strong recommendation for this indicated combined-care use; it does not cover every sexual dysfunction.
Scope: Men with erectile dysfunction; indicated CBT involving the partner and combined with medical treatment.
Assessment not yet completed (5)
No completed assessment or source check for this topic is recorded yet.
Eye Movement Desensitization and Reprocessing
Francine Shapiro · 1989
Emotion-Focused Therapy
Leslie Greenberg · 1990
Gottman Method
John & Julie Gottman · 1999
Psychoanalysis
Sigmund Freud · 1895
Somatic Experiencing
Peter Levine · 1997
Cases Featuring Associated Approaches
These teaching cases share approach links with this topic. They may illustrate a different presenting concern.
Reading This Page
Why are these approaches listed with Sexual Dysfunction & Intimacy Concerns?
The catalogue associates 6 approaches and 0 frameworks with this topic. These links support learning and comparison; association alone is not a treatment recommendation or evidence of effectiveness.
How should I read the evidence assessments?
Assessments are specific to the population and scope stated on each card. They include a rationale, source links, and a review date. An overall review of an approach does not automatically apply to this condition, and a randomized-study label does not by itself mean that a study found benefit.
What does "Assessment not yet completed" mean?
A condition-specific assessment has not been recorded. Approaches with checked sources appear in a separate assessment-pending group; a checked source can support, oppose, or discuss an intervention without recommending it. Neither pending group means that no research exists or that the approach is ineffective. Frameworks are shown separately.
Sources and Review Scope
Source links and dates on assessment cards apply to the stated population and rationale. The clinical overview and prevalence text above are separate authored content; an approach's evidence label does not verify those statements. Recorded narrative notes and citations remain available on individual modality pages, with their review status identified. The bibliography provides further reading.